Customizing Your Treatment
After about 3 months on a DMARD, your doctor will take stock of how you're doing, based on how you're feeling, blood tests, X-rays, and other factors.
If your DMARD is working well, great. If it's not, you have a lot of options. You may switch to another medication. Or your doctor might add a second DMARD, like a biologic. "Different DMARDs have different ways of turning down the immune response," Bingham says. Sometimes combining them works best.
What other factors could affect your medication choices?
- Your symptoms. Some drugs work better with specific symptoms. For example, some RA medicines can make you more tired, but some biologic DMARDs can help relieve fatigue, Bingham says.
- Other health conditions. Some drugs might not be a good fit if you have other health problems. For instance, some biologic DMARDs may not be safe if you have heart disease or MS. If you drink a lot of alcohol, methotrexate is not safe.
- Your insurance. "In a lot of cases, what the insurance company pays for is the single most important factor in determining what drug you get," Bingham says.
What About Side Effects?
DMARDs do have side effects. Some of them -- like a risk of lymphoma and some other cancers -- can be scary. But experts say that people with RA sometimes worry too much about very unlikely side effects. And they don't worry enough about the serious damage that can happen if RA isn't treated.
"We do use strong medications for RA, but that's because it's a severe disease," Bingham says. "We have to treat it aggressively." Closely watching for any side effects can prevent problems, he says. Bingham also stresses that RA itself raises the risk of some cancers.
If you're concerned about the risks of side effects, talk them over with your doctor.
Sticking With Treatment
It's important to know that you may not see big changes from your RA treatment right away.
"People are sometimes disappointed when they don't get all the answers in that first meeting with me," Husni says. "But treating rheumatoid arthritis is a process. It takes time to come up with the best treatment plan."
Your treatment might also change over time. You may have flares sometimes and have to take painkillers or steroids for a while. For reasons that aren't fully clear, a DMARD that worked for years might also stop. If that happens, don't worry. There are plenty of other drugs that can help.
"Lots of people with RA are thriving these days," Husni says. "Obviously, no one wants to get it. But if you do get diagnosed, there's never been a better time to have it."